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MB-5840 - USA (Arizona) - Group Medical and Prescription Drug Plan Administration Service - Deadline December 15,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5840

Government Authority located in Arizona; USA based organization looking for expert vendor for group medical and prescription drug plan administration service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide employee benefits to active employees, their eligible dependents, and COBRA participants.
- A fully insured medical and pharmacy, (participating and non-participating agreement) benefit plans with current or a similar plan design for the July 1, 2022 through June 30, 2023 plan year.
• Provide a designated account manager and account management team
• Respond to questions from the district, or its representative, within 24 hours, even if the initial response is an acknowledgement of the request and not a resolution to the question.
• Provide a designated call and claim unit with toll free telephone access.
• Provide customer service to answer inquiries on claims, eligibility, services, coverage, or other inquiries from participants Monday through Friday from 8:00 AM to 6:00 PM (AZ time)
• Provide bilingual communication/educational materials
• Provide claims forms (as applicable)
• Determine benefits payable under the Plan, pursuant to the terms and conditions of the District’s Benefit Plan booklets
• Receive claims and process payments of benefits in accordance with the plan designs for all claims incurred
• Correspond with participants if additional information is necessary to complete the processing of claims
• Coordinate benefits payable under the Plan and with other benefit plans, if applicable
• Provide notice to the Participants regarding the reason for denial of benefits (which are denied) and provide for the review of such denied claims
• Provide an explanation of benefits resulting from claims transactions to plan participants
• Accept eligibility from the district (either through an online enrollment maintenance system or receipt of an Excel workbook submitted by the district)
• Administer eligibility based on the district’s eligibility criteria
• Enrollment by plan option, coverage tier and status (Active/COBRA)
• Premiums paid by plan option
• Access to enrollment/eligibility administration portal for employer
• Access to claims administration portal for employee to track medical and pharmacy claim history, compare medical service providers for quality and price, search for providers and print/request personal ID cards

[C] Eligibility:

- Onshore (US Organization Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Wednesday, 15 December, 2021

Category : Medical Billing and Coding

Country : USA

State : Arizona

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